RESUMO
This article describes and analyzes a new basic health care system approach termed Reference Teams, or health unit teams accountable for a reference population, organized in Betim, Minas Gerais. Empirical data and other forms of evidence were collected by the authors with the purpose of describing the project's history. Based on this experience and other studies on the subject, some theoretical reflections shaping models for health care reform were formulated.
Assuntos
Política de Saúde , Modelos Organizacionais , Administração dos Cuidados ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Brasil , Feminino , Planejamento em Saúde , Humanos , MasculinoRESUMO
There are 80 medical schools in Brazil, of which 14 were selected for this study based on their regional distribution and representative characteristics. A survey in 1995 showed a heavy concentration (86%) of in-house practical training in major university hospitals. Only 14% of the hands-on training of students occurred in primary health or community-based clinics or other services related to the nationwide Unified Health System (SUS). University hospitals have been organized according to the specialized ward model, with extensive fragmentation of health care. This article makes several proposals for improving medical training. Changes in medical care are considered crucial to improvement of physician training. Reforms in medical care in such hospitals would be more important than reformulating the medical school itself. A move towards other health care services is recommended; more time devoted to teaching in primary health care systems and other extramural services is crucial for achieving better physician responsibility and competence.
Assuntos
Atenção à Saúde , Educação Médica , Hospitais Universitários , Brasil , Currículo , Reforma dos Serviços de Saúde , Faculdades de MedicinaRESUMO
INTRODUCTION: In Brazil, one can verify an imbalance between the increase in the need for health care and its supply. The consolidation of the National Health System which recommends universality and equity in care, makes this issue important in the field of health service evaluation. Two pediatric services in a university hospital, one general and the other specialized are studied and compared in terms of their clients' access. METHOD: Questionnaires were applied to 221 users of the general pediatrics outpatient departments of one of the specialties with a view to studying and comparing socioeconomic and several other variables related to the access to these and other health services. RESULTS: A high level of difficulty in the users' locomotion from local health services to the hospital was noted. Of the patients attended, 40% did not receive any kind of care before their arrival and were dependent exclusively on State-run health services. The clients of the specialty were different as regards several variables when compared to the users of the general outpatients' department. The fact that they are at a better socioeconomic level and are less dependent on State-run services brings out the social inequalities involved. CONCLUSION: Socioeconomic conditions, as well as organizational aspects of the service, are seen to be both causes and consequences of social inequality verified.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Adolescente , Brasil , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Fatores Socioeconômicos , Fatores de TempoRESUMO
This paper describes a new health care management method. A triangular confrontation system was constructed, based on a theoretical review, empirical facts observed from health services, and the researcher's knowledge, jointly analyzed. This new management model was termed 'health-team-focused collegiate management', entailing several original organizational concepts: production unity, matrix-based reference team, collegiate management system, cogovernance, and product/production interface.
Assuntos
Liberdade , Administração em Saúde Pública/métodos , Brasil , Democracia , Pessoal de Saúde/organização & administração , Organizações de Planejamento em Saúde/organização & administração , HumanosRESUMO
This article aims to analyse the representations of doctors of public sector in Campinas, SP, Brazil, taking as reference the process of decentralization which the health reform being undertaken in Brazil is undergoing. It is assumed that the success of this reform will depend largely on the attitude that these doctors show towards its various aspects. The following subjects were then focused on: the policies and management of the health services, the health-disease process, the doctor-patient relationship and labour process as it affects the health team.